We will be performing site maintenance on our learning platform at learn.aaos.org on Sunday, February 5th from 12 AM to 5 AM EST. We apologize for the inconvenience.

David D. Teuscher, MD


Published 5/1/2014
David D. Teuscher, MD

Relationships that Matter Most

The American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) are twin organizations led by 20 directors, 3,707 volunteers, and a staff second to none. Together, we are the AAOS, serving more than 38,000 members who care for millions of patients worldwide. These are the relationships that matter most.

Each of us ran the proverbial orthopaedic educational gauntlet to become a Fellow of this Academy, with critical and life-changing experiences. Today I’ll share some of the less formal life lessons learned that resonate in my life every day.

I learned about experience from my faculty one day while brashly touting my readiness as a junior resident to perform a total knee arthroplasty, to which he wisecracked in response: “A string of unconnected negative events does not constitute experience.”

My residency chairman once heard me present a complex case at morning report and commented from the back of the room: “Teuscher, if BS was electricity, you’d be Hoover Dam.”

Hard work
One long, hot summer day working on my grandpa’s dairy farm, I complained, “Grandpa, this hard work is killing me.”

“David,” he answered, “hard work never killed anyone.”

From some outstanding nurses, I learned that patients don’t care how much you know until they know how much you care.

From my patients, I learned about the trust that exists when they are full of fear, pain, and uncertainty, expecting an A+ performance always.

Life lessons learned from mentors, family, nurses, and patients—all relationships that matter most. Let me touch on some inspiring relationships that have made a difference in the realms of service, research, and education.

From Baghdad to Boston
Over the course of a dozen years of combat casualty care in Iraq and Afghanistan, our uniformed colleagues have set a new standard of care for devastating injuries to our wounded warriors. Their innovations save lives and limbs and continue to be shared through education of colleagues, including civilians, in optimal care for these unique cases.

This same civilian-military relationship also worked well when civilian orthopaedic champions—including the AAOS—were able to help secure federal funding of more than $300 million since 2006 to fund extremity war injury research.

Equally impressive, a civilian-military partnership formed after the 2010 earthquake disaster in Haiti has resulted in the Disaster Response Course that already prepared 198 civilian orthopaedists to undergo a credentialing process that will enable them to rapidly deploy as disaster responders in the next international or federal disaster call for volunteers.

Then, it all came home last April, with the carnage on the streets of Boston. One of my heroes is General Stonewall Jackson, whose motto was “Ride to the sound of gunfire.” That’s exactly what our Boston colleagues did on that fateful day, as they dropped everything to ride and run to emergency departments clogged with runners and spectators mangled with blast injuries—wounds that the surgeons and their teams were prepared to optimally manage. America, indeed the world, took note of that response.

These experiences show us the power of relationships and why they matter so much to what we do. Be it Boston, Baghdad, or Bagram, you have made us proud to be counted among you.

Meeting challenges
Today, the Medical Industrial Complex, as some have called it, includes insurers, hospitals, healthcare systems, manufacturers, lawyers, and three branches of government—all with a heavy hand in how we practice. Again, these challenges require investment in relationships with all involved.

Yes, healthcare policy is made by those that show up. Your AAOS is involved in patient advocacy in all three branches of our federal government through legislation, regulation, and litigation.

We won’t be successful unless we play in all three arenas. But our staff can’t do it alone; volunteer members like you and your patients are essential to making our case powerfully in the public arena.

You may be thinking that you are too overwhelmed with patient care, research, teaching, or just too busy trying to get a life to get involved. You may say that Washington gridlock means somebody else can advocate on behalf of your patients and your practice. I couldn’t disagree more.

While you are distracted by the important work you do, others are passing laws, writing regulations, and winning litigation that will impair or restrict your ability to practice and deliver access to high-quality orthopaedic care for your patients. As orthopaedists, we are best qualified to advocate for our patients, and you may have the greatest impact and success in your state capitol.

Let me share three quick examples from my home state of Texas of what can be done by a committed group of volunteers. First, we passed landmark medical liability reform in 2003, then we amended the Texas Constitution to make it permanent. Second, when the Texas podiatry board tried to expand their scope of practice by rewriting the definition of “foot” to include the ankle and leg, we took them to court—all the way through to a State Supreme Court victory. Third, we helped regulators write Workers’ Compensation rules for a rational, national-model physician fee schedule unhitched from Medicare, with an annual automatic increase for inflation.

None of those successes was preordained, and each hung in the balance and was only possible because of long-term relationships that mattered the most. The pathway to leadership is active followership; for our leaders to succeed, they must seek first to honor those relationships that matter most with our patients, our profession, and our future.

I am grateful for the privilege of serving as a leader of this great organization.

David D. Teuscher, MD is the AAOS first vice president.